中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (9): 1677-1680.doi: 10.3969/j.issn.1673-8225.2010.09.037

• 骨与关节学术探讨 • 上一篇    下一篇

人工髋关节置换后的深静脉血栓形成：发生因素及其预防策略

马 骊1，王 欣2，蒋丽华3   

  1. 1沈阳医学院临床实验中心外科手术室，辽宁省沈阳市   110034
    2沈阳市第四人民医院外科，辽宁省沈阳市  110031；3沈阳医学院附属卫生学校外科，辽宁省沈阳市  110034
  • 出版日期:2010-02-26 发布日期:2010-02-26
  • 作者简介:马 骊，女，1958年生，辽宁省沈阳市人，汉族，2006年沈阳医学院毕业，高级实验师，主要从事外科手术方面的研究。 mali1958@sina.com

Occurrence factor and preventive strategy for deep venous thrombosis following artificial hip replacement

Ma Li1, Wang Xin2, Jiang Li-hua3   

  1. 1Surgery Room of Clinical Experimental Center, Shenyang Medical College, Shenyang  110034, Liaoning Province, China;
    2Department of Surgery, Shenyang Fourth People’s Hospital, Shenyang  110034, Liaoning Province, China
  • Online:2010-02-26 Published:2010-02-26
  • About author:Ma Li, Senior experimentalist, Surgery Room of Clinical Experimental Center, Shenyang Medical College, Shenyang 110034, Liaoning Province, China mali1958@sina.com

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摘要：

目的：近年来有关人工髋关节置换后深静脉血栓形成的研究很多。文章总结人工髋关节置换后深静脉血栓形成的因素及预防措施。
方法：由第一作者应用计算机检索维普数据库(http://www.cqvip.com/)与髋关节置换后深静脉血栓发生有关的文献，检索时限为1994-01/2009-10。检索关键词：髋关节置换，深静脉血栓。纳入标准：①髋关节置换后深静脉血栓形成因素。②深静脉血栓形成的诊断标准及诊断方法。③预防人工髋关节置换后深静脉血栓发生的措施。排除标准：重复研究或较陈旧文章。依据纳入排除标准共保留相关文献25篇。
结果: 目前国内外对于人工髋关节置换后下肢深静脉血栓形成的发病机制与危险因素基本已达成一致意见，发病机制主要有：血液高凝状态、静脉血流缓慢(或郁滞)、血管壁的损伤。高龄、心脑血管病、静脉曲张或静脉手术是并发深静脉血栓的危险因素。人工髋关节置换后深静脉血栓的预防性治疗主要有机械性和药物性预防两种方法，机械性疗法无药物不良反应，易被患者接受，但对高风险患者治疗效果尚不能肯定，需结合药物预防性治疗以获得较确切的治疗效果。低分子肝素已成为人们预防术后深静脉血栓形成的首选药物，是目前最常用、效果最可靠的手段。
结论：对人工关节置换后深静脉血栓的影响因素和预防性治疗已受到医务界的极大关注，掌握人工髋关节置换后发生深静脉血栓的发生机制、相关因素以及预防措施等知识，对降低深静脉血栓的发生率有重要意义。

关键词: 髋关节置换, 深静脉血栓, 形成因素, 预防措施, 髋关节假体

Abstract:

OBJECTIVE: A series of studies has been reported concerning deep venous thrombosis following artificial hip replacement. This paper is aimed to summarize the occurrence factor and preventive measures for deep venous thrombosis following artificial hip replacement.
METHODS: A computer-based online search of VIP database was undertaken by the first author to identify the articles about the deep venous thrombosis following artificial hip replacement published in between January 1994 and October 2009 with the key words of “artificial hip replacement and deep venous thrombosis”. Inclusive criteria: ①Occurrence factor of deep venous thrombosis following artificial hip replacement. ②Diagnostic criteria and diagnostic methods of deep venous thrombosis following artificial hip replacement. ③Preventive strategy for deep venous thrombosis following artificial hip replacement. Inclusive criteria: repetitive research or obsolete documents. Totally 25 literatures were included in this paper.
RESULTS: The agreement has been basically achieved for pathogenesis and risk factor of deep venous thrombosis following artificial hip replacement. The pathogenesis included blood hypercoagulable state, slow blood flow (or stasis), and vessel wall damage. Meanwhile, elderly, cerebrovascular disease, varicose vein or intravenous surgery, were the risk factors of deep venous thrombosis. Mechanical therapy or medication could be selected for preventing patients against deep venous thrombosis following artificial hip replacement with different features. It was an acceptable method for most patients using mechanical therapy, which could not induce drug adverse reaction, but the clinical efficacy remained uncertain for high-risk patient population, thus, medication should be combined. Low molecular heparin was considered first-choice drugs for preventing deep venous thrombosis following artificial hip replacement, which was characterized by common uses and reliable effects.
CONCLUSION: Studies on influencing factor and preventive treatment of deep venous thrombosis following artificial hip replacement has arisen more attention in medical circles. The understanding of pathogenesis, correlation factors and preventive measures plays an important role in decreasing incidence deep venous thrombosis.

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